Depression assessment tools for children

Here are some crucial differences between screening and assessment tools. Mental health screening and assessment tools are beneficial because they help clinicians diagnose and treat patients quickly and accurately. Understanding the different types of screening and assessment tools available allows you to make an informed decision for each patient.

In some situations, your patient may not recognize the symptoms and disorders they are experiencing. General mental health screenings like the Kessler Psychological Distress Scale, Patient Stress Questionnaire or My Mood Monitor checklist check for early signs of mental health symptoms. Primary care doctors may also use these screenings during regular checkups to refer at-risk patients to behavioral and mental health specialists.

If your patient shows signs of depression or has a family history of depression, screenings like the Patient Health Questionnaire PHQ may help give a more definitive answer. Screenings for drug and alcohol use may help identify destructive habits or addictions in patients.

To help identify symptoms of bipolar disorder, clinicians may use the Mood Disorder Questionnaire. Because bipolar disorders exist on a spectrum, it may also help to use the Bipolar Spectrum Diagnostic Scale to determine where or if your patient registers.

Anxiety disorder screening can help you determine if your patient exhibits symptoms of generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder PTSD or social phobia. This tool checks for common sources of PTSD or extreme distress. Talk to your patient to determine which screenings may be necessary.

After you have highlighted areas of concern, you can use assessment tools to understand the depth and scope of individual problems. Different age ranges have unique needs regarding screening tools. For example, a young child might lack the vocabulary to describe their symptoms as fluently and accurately as an adult can. They need a screening test they can respond to.

Here are recommendations for depression and anxiety screening — two of the most common mental disorders — for various age groups. According to the Centers for Disease Control and Prevention , 3.

Depression is a risk factor for substance use , suicide, declining academic performance and poor health choices. In particular, teens might repress their feelings or turn to friends rather than adults for help with depression or anxiety. Fortunately, screening tests help physicians and behavioral health professionals catch depression and anxiety early on, so they can begin treatment.

The U. Preventive Services Task Force USPSTF recommends that primary care physicians screen adolescents aged 12 to 18 for major depressive disorder if the clinician can ensure an accurate diagnosis and effective treatment. Effective and widely used screening tools for depression in adolescents are the PHQ-9 and the Patient Questionnaire for Adolescents — a slightly modified version of the PHQ You might also use the Kutcher Adolescent Depression Scale to screen for depression in patients ages 12 to Pediatricians, psychiatrists and other health professionals might use the Pediatric Symptom Checklist , a short questionnaire, to screen for depression and anxiety in children ages 4 to The Child Depression Inventory, a modified version of the Beck Depression Inventory, is another way to screen for depression in children ages 7 to Parents can collect the information to help a young child complete a screening test.

Anxiety is even more common than depression in childhood and adolescence, with 7. Depression and anxiety can make it challenging for people to meet daily responsibilities, maintain relationships and take care of their health. According to the World Health Organization , depression is the top cause of disability worldwide.

Due to the prevalence and severity of depression in adulthood, the USPSTF and American Academy of Family Physicians recommend screening all adults over 18 for depression, regardless of risk factors.

PHQs are the most widely used depression screening tools for adults. Physicians should also consider screening for depression in pregnant and postpartum women.

According to a review published in BMC Psychiatry , both of these tools were the most commonly validated for anxiety disorders. Screening for depression and anxiety becomes more challenging for older patients.

If a patient has dementia, clinicians must choose an appropriate mental health screening tool. Anxiety often goes undiagnosed in older adults because patients and doctors might assume a medical condition or prescription medication causes the condition.

If left untreated, anxiety can lead to physical health issues, cognitive dysfunction and a lower quality of life. Screening tools designed for older adults can help them get treated. You might use the Geriatric Depression Scale, which features yes-or-no questions, to screen for depression in older adults, including patients with cognitive impairment.

The PHQ-2 is another valuable screening tool for depression in older patients. The Geriatric Anxiety Scale is a widely used anxiety screening and assessment tool for older adults. According to a systemic review , the Rating Anxiety in Dementia scale is a validated screening tool for anxiety symptoms in patients with dementia.

Behavioral and mental health screening and assessment options exist to help you make informed decisions as you work with patients. Using the right tools can help maximize your appointments and help you provide the best care possible.

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Behavioral health case management is a multifactor job. This comprehensive field requires…. Post-traumatic stress disorder PTSD happens after someone experiences or witnesses a traumatic event,…. Dialectical behavioral therapy DBT , also called dialectical behavior therapy, gives patients a…. Due to back-to-back appointments where healthcare professionals are trying to play catch-up,….

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Group Therapy. Emotional and cognitive developments influence the symptom presentation, so do comorbidities. Onset of depression in childhood often results in poor academic outcome, long-standing impairment, poor quality of life, and high risk for suicide and substance abuse.

He was sent for psychiatric care when no physical basis of symptoms could be identified. His vomiting would become worse when he approached school so much, so that his parents stopped sending him to school. He appeared dull, listless, became jittery when offered the chair. He did not look at the crayons or balloons which were his favorite.

Earlier an Avid Reader, she would not even feel like looking at her books and would often get reprimanded for keeping her belongings in a disorderly manner. She would not take the phone from her mother even when offered to talk to her aunt, which she used to earlier fight for.

Although the diagnostic criteria for diagnosing depression remain the same even for children and adolescents, application of these is often felt difficult as symptoms differ by age due to cognitive, emotional, and social aspects of development. Biological functions such as sleep and appetite may not be disturbed, but experience of low mood, anhedonia, and cognitive distortions is distinctly felt.

Childhood depression is currently conceptualized to be similar to depression in adults. Clinical presentation varies as per the level of development, comorbidities, course, and outcome are also different from depression in adulthood. While children may not verbalize feeling depressed, there may be irritability, temper tantrums, mood lability and low frustration tolerance, somatic symptoms, and withdrawn behavior.

Symptoms of depression vary as per age and developmental level; affective symptoms and cognitive distortions in childhood are similar to adults, whereas biological symptoms such as changes in sleep and appetite are different. Hypersomnia, decreased appetite, and weight loss are more common in adolescents as compared to children.

Delusions are also uncommon in children. Negative cognitions such as low self-esteem, hopelessness, and negative attributions are common in children. This Axis I disorder comprises anxiety disorders, conduct disorders, and attention deficit hyperactivity disorder.

The most common comorbidity being separation anxiety disorder in children. Both parent and child interviews are needed for diagnosis of depression. Furthermore, contextual factors such as family environment, school problems, and interpersonal difficulties need to be assessed to ascertain their role as precipitating and perpetuating factors for depression. Assessment of risk for suicide is also essential to monitor the ongoing suicide risk if any.

More structured assessment is then taken up to assess symptoms and severity of depression. All these initial assessments are continued on an ongoing basis to monitor clinical progress. In addition to clinical interviews, other methods like pictorial instruments can be used, which can be useful for better clinical understanding of mental state of children because of their age appropriateness in communicating abstract thoughts and emotions.

Pictorial instrument which uses concrete means of visual communication provides a way of reducing the impact of cognitive difficulties, attentional problems, and language limitations inherent in verbal interviews.

PICA-R generates a categorical diagnosis with dimensional severity rating. Pictorial Instrument for children and adolescents for depression: Do you get like him? How much? Do you feel sad the way he does? Do people tell you that you look sad? What about crying? How much does it happen to you?

Structured assessment scales which include clinician-rated and self-rated scales that are used for symptom assessment of depression. Many of these scales are available free of cost and can be used to assess symptoms and monitor treatment response to guide therapy [ Table 1 ].

While there were concerns by pharmacological trial experts regarding risk of suicide in children prescribed with antidepressants, epidemiological studies established that the risk of suicide decreased with increased prescription of antidepressants.

Initial improvement of energy levels with intake of antidepressants may increase suicidality, therefore, it is imperative to monitor and systematically assess suicidality during the initial phase of the treatment. Incidence of suicide attempts peak during adolescence, particularly from middle-to-late adolescence. Associated depressive disorder is one of the two most important risk factors for suicide, the other being previous suicide attempt.

Assessment of suicide risk is recommended to be done routinely in depressed children and adolescents. Assessment of suicidal patient includes assessment of suicidal behavior, underlying psychopathology and psychosocial contributory risk factors.

Protective factors such as family cohesion, supportive atmosphere, and religious beliefs need to be considered while formulating treatment plan. Assessment of suicidal behavior involves collection of information from parents, teachers and friends, and relatives who are close to the child. Thorough evaluation of suicidal ideation, previous planning, attempts and their lethality is essential.

Use of semi-structured and structured self-rated or clinician-rated instruments has high sensitivity but low specificity.

Furthermore, these scales have low predictive value for assessing suicidality. Scales cannot be used as stand-alone measures for suicide assessment and are meant to be used in addition to clinical assessment. Sample questions for assessment of suicide in children are mentioned in Table 2.

Treatment is divided into acute, maintenance, and continuation phases. This period may range from 2 weeks to 2 months. It is aimed at consolidation of gains achieved in acute phase and prevention of relapse. It is defined as recovery phase where the aim is to prevent any recurrence of depressive symptoms. Psychosocial management of depression in childhood remains the mainstay. A diagnosis of major depressive disorder MDD as per DSM5 needs either depressed mood or loss of interest or pleasure with at least five other biological, affective, somatic, and cognitive symptoms for a period of at least 2 weeks [ Table 3 ].

Mild depression is defined as few symptoms in excess of diagnostic criteria for MDD, minimal distress, and impairment [ Figure 3 ]. In cases of mild depression without suicidality or psychosis nonspecific psychotherapy for 1—4 weeks may be sufficient to produce relief. Psychoeducation: Psychoeducation refers to education of patient and family members about symptoms of depression, its causes, risk factors for depression, course, available treatment modalities and risks, and benefits associated with various treatments.

Patient and family members are guided toward establishing a collaborative relationship wherein they are expected to contribute toward their own treatment. Depression is presented as a medical illness rather than a weakness of personality, so that the behavioral problems of the child are understood as symptomatic manifestation of depression rather than manipulation or fault of personality.

The natural course of depression as a chronic, recurring, and relapsing illness is focused on wherein parents are taught to provide ongoing monitoring of symptoms and support.

Parental expectations are being addressed and need for treatment adherence emphasized. Parents are also advised to supervise medication intake and to keep medication stock in their custody. Appropriate limit setting is also taught in which parents are guided toward maintaining their giving in or being excessively punitive[ 1 ]. Supportive psychotherapy: It includes skill of empathic listening, reflecting, general problem-solving, and advice.

Bringing together stakeholders to shed greater light on mental health issues through science and stories at Sapien Labs is challenging yet so fulfilling.

Callyn joined Sapien Labs in and manages marketing and events, including coordination of all virtual symposia which she has helped design and launch. She also supports the marketing outreach of the WorkforceMHQ product. She has over 10 years of experience working in marketing and events and previously managed large trade shows and hosted events, including all aspects of event strategy, planning, execution, marketing and communication. Callyn has an M. It is an honor to be part of an organization that has amazing ambitions — improving mental health on a global scale.

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